儿童急性肾损伤预防措施有效性评价的Meta分析

Meta-analysis of effectiveness evaluation of preventive measures for acute kidney injury in children

目的综合评估儿童急性肾损伤(AKI)的预防措施,找寻有效预防方案。方法计算机检索中国知网、万方、维普、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library数据库和相关文章参考文献列表,搜集预防儿童AKI的随机对照试验,时间限定为建库至2023年12月。按照纳入和排除标准筛选文献,对最终纳入文献进行数据提取和质量评价并进行传统和网状Meta分析和试验序贯分析(TSA)。结果共纳入21项研究,包含3483例患儿。传统Meta分析和网状Meta分析显示,右美托咪定可以有效预防心脏术后或心脏造影术后患儿的AKI(OR=0.26、0.27,95%CI 0.11~0.64、0.13~0.58),远端缺血预处理(RIPC)可以有效预防心脏术后患儿的AKI(OR=0.43、0.44,95%CI 0.24~0.79、0.23~0.83)。传统Meta分析和针对脓毒症或脓毒性休克患儿的网状Meta分析显示,平衡盐溶液可以有效预防儿童AKI(OR=0.58、0.52,95%CI 0.42~0.79、0.37~0.73)。TSA显示右美托咪定(348例)和RIPC(666例)的总样本量均达到所需信息量(320、534例),平衡盐溶液的Z值曲线(累积Z=3.38)穿越TSA监测边界(Z=3.29)。结论右美托咪定可以降低心脏术后或心脏造影术后患儿群体AKI的发生风险,RIPC可以降低心脏术后患儿群体AKI的发生风险,平衡盐溶液可以降低脓毒症或脓毒性休克患儿群体AKI的发生风险。

Objective To comprehensively evaluate the effectiveness of preventive measures for acute kidney injury(AKI)in children and identify the effective strategies.Methods Databases were systematically searched including CNKI,Wanfang,VIP,China Biology Medicine National Knowledge Infrastructure,PubMed,Embase,Cochrane Library databases,and the reference lists of relevant papers for randomized controlled trials on preventing pediatric AKI up to December 2023.Literature screening was conducted based on the inclusion and exclusion criteria,followed by data extraction and quality assessment of included studies.Traditional and network meta-analyses were performed,along with trial sequential analysis(TSA).Results A total of 21 studies involving 3483 children were included.Traditional and network meta-analysis showed that dexmedetomidine was effective in preventing AKI in children undergoing cardiac surgery or cardiac angiography(OR=0.26,0.27;95%CI 0.11-0.64,0.13-0.58).Remote ischemic preconditioning(RIPC)was effective in preventing AKI in children after cardiac surgery(OR=0.43,0.44;95%CI 0.24-0.79,0.23-0.83).Traditional and network meta-analysis specific to children with sepsis or septic shock showed that balanced solution was effective in preventing pediatric AKI(OR=0.58,0.52;95%CI 0.42-0.79,0.37-0.73).TSA indicated that the total sample sizes of dexmedetomidine(348 cases)and RIPC(666 cases)both reached the required information size(320 and 534 cases);additionally,the Z-curve for balanced solution(cumulative Z=3.38)crossed the TSA monitoring boundary(Z=3.29).Conclusion Dexmedetomidine reduces the risk of AKI in children undergoing cardiac surgery or cardiac angiography,RIPC decreases the risk of AKI in children after cardiac surgery,and balanced solution lowers the risk of AKI in children with sepsis or septic shock.